Provider Demographics
NPI:1154933455
Name:JB DAVIDSON INC
Entity type:Organization
Organization Name:JB DAVIDSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOROHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-876-4388
Mailing Address - Street 1:1946 LAKE WINDS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1708
Mailing Address - Country:US
Mailing Address - Phone:832-876-4388
Mailing Address - Fax:
Practice Address - Street 1:1946 LAKE WINDS DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1708
Practice Address - Country:US
Practice Address - Phone:832-876-4388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities